Comparison of Two Commonly Used Sequential Therapy Regimens for Eradication of Helicobacter Pylori Infection

Abstract

To compare the efficacy of levofloxacin based and clarithromycin based sequential therapies for eradication of Helicobacter pylori infection. Methods: From january 2017 to december 2018, 260 patients with H. pylori infection randomly received 14 d of levofloxacin-based sequential therapy (LEVO-ST group, n = 130) or clarithromycin-based sequential therapy (CLA-ST group, n = 130).H.pylori infection was defined on the basis of either histologic evidence of H. pylori by modified Giemsa staining; or a positive rapid urease test by gastric mucosal biopsy. Successful eradication therapy for H.pylori infection was defined as a negative 13-Carbon-urea breath test four weeks after the end of eradication treatment.Compliance was defined as good when drug intake was at least 90%. H. Pylori eradication rates, patient compliance with drug treatment, adverse events, and factors influencing the efficacy of eradicationtherapy were evaluated. Results: The eradication rates by intention-to-treatanalysis were 89% (116/130; 95%ci: 86.2%-95.4%)in the levo-st group and 86% (112/130; 95%ci:65.8%-77.4%) in the cla-st group (p = 0.450). Theeradication rates by per-protocol analysis were 91%(114/124) 95%ci: 89.1%-98.1%) in the LEVO-ST groupand 87% (106/122; 95%ci: 69.4%-81.8%) in the CLA-ST group (p = 0.227). Compliance was 100% in bothgroups. The adverse event rates were 17.6 % (22/125) and 28.6% (35/122) in the LEVO-ST and CLA-ST group,respectively (p = 0.038). Most of the adverse eventswere mildto-moderate in intensity; there was none serious enough to cause discontinuation of treatmentin either group. Conclusion: The 14-d levofloxacin-based sequential therapy has high efficacy for H. pylori eradication effective. Moreover, it showed excellent patient compliance and safety compared to the 14-d clarithromycin-based sequential therapy.